An estimated 830 women die from preventable causes related to pregnancy and childbirth every day. Ninety-nine percent of these deaths happen in developing nations. Women and newborns can be saved when there is skilled care before, after and during childbirth. As per the WHO, the Maternal Mortality Ratio is 239/100,000 in developing nations and 12/100,000 in developed regions, which indicates that pregnancy-related complications can prove to be fatal for mothers. Pregnancy-related acute kidney injury is a major cause of maternal and fetal morbidity and mortality. The most affected are socially, educationally and economically disempowered women in low-income countries.

What is Acute Kidney Injury

Acute Kidney Injury is a major health problem that occurs in 21 percent of hospital admissions globally. Formerly called as acute renal failure, acute kidney injury is a ‘functional or structural abnormality of the kidney that manifests within 48 hours, as determined by blood, urine or tissue tests or by imaging studies’. It is also defined as, ‘A sudden decline in renal function with associated increases in metabolic waste products such as blood urea nitrogen (BUN) and serum creatinine.’ AKI is often associated with decreased urine output and a failure to eject nitrogenous waste products. This, in turn, could lead to fluid and electrolyte imbalances.

AKI used to be considered a completely reversible syndrome, but recent studies have implied that it may escalate the risk of developing chronic kidney disease (CKD) and lead to permanent kidney damage. According to a study in the Journal of the American Society of Nephrology, women with AKI, even those who had completely recovered their kidney function before pregnancy are at high risk of adverse pregnancy outcomes. Women who had delivered infants between 1998 and 2007 at the Massachusetts General Hospital were observed as part of the study. A total of 105 women with recovered AKI and 24,640 women who did not have a history of kidney disease were the subjects.

It was found that women with recovered AKI (r-AKI) delivered infants earlier than those with no AKI. They also had infants that had higher rates of small-for-gestational-age births at 15 percent as compared to the 8 percent for women with no r-AKI. Out of the 189 perinatal deaths, 3.0 percent of offsprings’ mothers had r-AKI. It was found that r-AKI increased risk of preeclampsia by 4.7 times and increased risk of adverse pregnancy outcomes by 2.1 times. Factors considered were age, race, body mass index, diastolic blood pressure, parity and diabetes status. Those caring for reproductive-age women must take the study into account when counselling women with a history of AKI and inform them of the risks. Even minor renal damage can contribute to poor pregnancy outcomes and more research in the future can explain why women with r-AKI are likely to develop pregnancy-related complications.

The cause for injury is identified and then the doctor lays out the treatment options for AKI. The doctor will try to prevent any complications and based on the cause, recommend treatment options. For instance, if the AKI is caused due to lack of fluids, the patient will be given intravenous (IV) fluids. However, in the case of too much fluid, the patient will be prescribed diuretics to help your body expel extra fluids. Patients with kidneys failing to filter potassium will be given medication containing sodium polystyrene sulfonate (Kionex), glucose or calcium. Calcium infusions are prescribed for those with low levels of blood calcium. Some AKI patients have to undergo dialysis to have toxins and excess fluids removed from the body.

Treatment for AKI in India is a challenge due to a shortage of nephrologists. For a country of 1.3 billion, India only has a total of 850 qualified nephrologists. Many factors are responsible for the shortage of specialists in the area of nephrology and include lack of exposure, inadequate training, rising costs of medical education, inflexible work hours among many others. Efforts must be made both globally and nationally to develop trained nephrology workforces in order to treat an increasing number of patients with kidney diseases like AKI. Trained nephrologists can provide quality care and save the lives of those affected. With the help of trained nephrologists, pregnant patients at the risk of AKI  can be identified and monitored to prevent any pregnancy-related complications arising from the disease.